Tracie’s travel thoughts after our IVF Vacation in Costa Rica and Panama:

Tracie’s travel thoughts after our IVF Vacation in Costa Rica and Panama:


Things to be aware of: everything takes longer, more money, and more hassle than it does in the US.

“Pack half as much stuff, and bring twice as much money. “

Hindsight –

Hotels: I would have splurged and stayed right near the hospitals in a nice hotel. We don’t usually travel that way, but in this case, the stress of traveling from hotel to hotel, and navigating the roads, tolls, and simply trying to find the clinic, lab, pharmacy, etc… was too much stress. (and we are usually “stay in a cheap clean hotel and forage for food ourselves” kind of travelers.) Take a shuttle or cab from the airport, skip renting cars, and just enjoy your time there. Most tours will pick you up. I’m not kidding about the roads – they are truly horrible. And it’s HOT there. You won’t feel like being outside unless it’s in the water. Make no plans prior, and just do what you feel like. We actually did very little “touristy” things, but we had a toddler in tote.

Money: Costa Rica is very expensive. Even buying groceries, expect twice what you pay in the USA for some things. Denny’s for 3 adult burgers and two kid’s meals was $68. Most tours are around $100 per person, and expect to be gone all day, as most are 2-4 hours from San Jose. Most tours are not appropriate for young kids. Rental cars will be at LEAST twice what you are quoted, for insurance. Even if you have insurance thru your credit card. Our quote was $210, and the final cost was $479. Cars are smaller there too… a whole class or two smaller than you’re used to. Mark the previous damage carefully with the agent.

Panama was very much like the US, cost-wise. Some things are much cheaper. The nice resorts are at least an hour out of town, traffic sucks.

One thing we did that I do suggest: we traveled to Puntarenas, CR… to the Double Tree (all-inclusive) resort, during that 1st week stimming. (although you really could start stimming at home and just come to Dr. Perez by day 6) Taking the new toll road the drive is about 90 minutes, and the resort is lovely. We booked about $129 a nite per person (remember AI) and it was well-worth that money. The upgrade to high end booze or building three is not worth it, IMO.

If you want to escape to Jaco for a few days, the ride back to San Jose is about 90 minutes via that same toll road, and I have VERY nice condo to recommend near it all. $90 or so a nite, 2BR, kitchen, pool, etc. from a very nice American couple. I also have an acupuncturist/massage lady in Jaco that I adore. She’s willing to travel to San Jose if more than a couple of you “hire” her.

Knowing simple Spanish will help a lot. Some English is spoken, but not as much as I had hoped. Dr. P’s nurses speak very little English, but I did not need them at all. Remember you are in THEIR country, and they are not required to speak English just because you do. Speak slowly, with simple words to get your point across. We did have a couple times where we felt Dr. P’s English was not sufficient enough to understand what we were saying. When in doubt, ask him to repeat it, or say “tell me again what you mean, please.”



Money:

Bring lots of USD $20, no larger bills if you can help it. CR will take USD, and Panama uses them as their currency. Tips are usually included, check the menu for details. We used our credit card (that does not charge a conversion currency fee) and small bills. Save all your small colonies (local currency) in one handy place if you’re driving, there are many highways that have tolls of 200-500 colonies ($1-3) each. (be aware that there are “quick pass” lanes on the far right, avoid them since you’re paying cash.)

Petty theft is HUGE in Costa Rica – watch your wallets, cameras, anything left on your table as you eat, and turn your head away… but we felt very safe. But we are “seasoned” travelers. Most neighborhoods, resorts, and even the stores, have lots of security guards. When in doubt, just ask the front desk or a local. Lock your doors when driving, and know where you’re going.



Doctor:

Dr. Perez was very pleasant. According to a local (who moved from Chicago 5 years ago with her husband) Dr. Perez is “thee” doc to see in CR for IVF. His walls are filled with tons of piks of the babies, and his schedule is booked SOLID 8am to 7pm six days a week. He is VERY busy. He is very straight to the point, and does not use extra words in any way. You may feel rushed in your appt, although we often waited 60-90 minutes past our appt. time to see him. Ask your questions in a simple way, straight to the point. NO EXTRA WORDS. There was a language barrier to some extent. Make sure he understands what you are asking. (I have found working thru Mark Semple, Passport Medical, MUCH easier, in a huge way, but keep in mind, he won’t butt in your personal doc-patient relationship. That’s not his role.) Dr. P is a perfectionist, and his office, the way he does things… it’s all done with precision and attention to detail. Not my style in a buddy, but for a doctor, I’ll take it! A sense of humor gets lost in translation. Don’t even try. Het het.

All said and done… this way is great if you’re looking to do a standard antagonist protocol IVF, and don’t have anything too far outside the box. It’s a bit of a “one size fits all” approach to doing it, which he seems to pull off amazingly well. I personally think he overshoots the moon to get you pregnant, and didn’t seem worried for one second about putting in too many. He even made the comment – “do not worry, many die early anyways.” Um, not what this momma wants to hear. I got the feeling he cares very little about your history, diagnosis, etc. Just do A, B, C and he’ll get you D. I can’t really say this is “bad”… but it’s different. There will be no coddling. Sorry. None.

The ER & ET office is tiny. You literally get knocked out while laying on a small table under a shelf. It was kinda funny. You do not get a fert report, he does not see what you have until you are standing there on day 3 outside the glass. We insisted on a few minutes to discuss (alone) which he willingly gave us. I’m actually questioning the “extras” like embryo glue, assisted hatching, etc. but can’t make claims. I just suspect those are fluff words. He says he’ll go to day 5, but we didn’t have that luxury. (nor did anyone we knew) I wore a tank top under my paper robe. They are very small. I am not. Ha. I was in a LOT more pain than I planned on. Ouch. He says you can swim after ER, but not after ET. It was so hot, I did swim in pools, not oceans, post-ER. I stay dry post-ET. DO NOT GET SUNBURN. You’ll be miserable.

We paid the $2450 in cash to him (or you can wire the money) and the clinic the (3) u/s appts by credit card. ($75 each?) Other costs unexpected were: estrogen patches to help my lining $90, E2 bloodtest $40, and the progesterone he offers, $100. (be aware it’s 17P, and once I did my homework, I found that to be a dangerous form of p4 to take in my case. It’s been taken off the market in the US, and only used to prevent PTL, later in pregnancy, and there are many issues I take with it. But do your own homework, or just bring a couple bottles of PIO with you from home. )

All in all, I am happy I did it this way. Like I’ve said all along… a $20K failed IVF would have been too much to swallow. I think this trip cost us under $7K. (we had hotel perks, however).

If you have any additional questions, I am more than willing to help.

-Tracie

Gracias.

Buenos. Tracie here.

On the day before I get to "meet" my "children"... I'm excited. I'm nervous. I'm guarded to say the least. Remember, it's not the getting pregnant that's the problem, it's STAYING pregnant. Tomorrow we hear what we've made, and how they've done the past couple of days on their own. So far we're 10 for 10, I can't wait to hear where we're at, and what we'll end up transferring! (and dare I say putting on ice?!)

While I wait, I wanted to take a moment to thank a few people that helped us get here. Because regardless of how this ends up, and what the outcome is, I am most thankful for the following people that helped get me here:
--My "med angels." If it was not for the (3) gals that took the time, love, money and effort to ship me their leftovers, this trip would have been so much more expensive. One of the hard parts of infertility treatments is shooting $100 shots into your belly several times a day for weeks. You have to trust that something so outrageously expensive is going to WORK! I am forever in awe of your generosity, and thank you from the bottom of my heart.

--My OB/RE "Dr. Hee" and his adorable (former) nurse Lindsay. It's been a long road getting to this point, and you have both been very patient and kind.

--Dr. Google. What would I do without easy access to medical journals and other info taken with a grain of salt.

--"My girls" on the board. Point blank, I could not have survived this without the pom poms, love, support, slaps in the face, puppies, rainbows and countless "gives it to me straight" advice.
So say "THANK YOU" seems trite. But Thank You.

--Minnesota Community Acupuncture. (http://www.minnca.com/)  I am giving acupuncture a HUGE bit of the credit for getting me 10 eggs retrived. I'm old, I make bad eggs. I am a high-stress person filled with anxiety. Kerri helped me not only take that time each week to relax and unwind, but never made me feel dumb for being so anxious about the process. I want to acknowledge their unique business model of "community style" acupunture, and by sharing the space with a couple other people in the room, I was able to afford going there more often than I ever thought possible, financially, and I didn't feel bad about spending the money. Sure, we all had to listen to eachother snore here and there, but the ambiance and 1:1 attention was still there. lol. I am forever grateful for your services, and the affordability you provided. Thank you.


--Micah at Costa Rica Massage in the beach village of Jaco. I was able to contact her prior, and knew she could help me get "back in line" again prior to my travels to Panama for ER/ET. Although she's about 60-90 minutes from San Jose, we happen to be staying in this area, and I saw here for a blissful hour of relaxation. She's open to traveling to the San Jose area if you have a group of you requesting her services. AMAZING massage, very knowledgable acu techniques, and I felt amazing after we met. And she is one of the prettiest souls I've ever met. Just a beautiful person, and I am very thankful to have her on my list of people that helped make this IVF Vacation possible.  Her email is michalgm@yahoo.com  and her website is at http://www.costaricamassage.com/ . I cannot recommend her enough. She was wonderful.

--I'd also like to thank my friends and family for their amazing support, Mark Semple from Passport Medical for making this all come together, (Christa's) Adam's parents, for their kind and generous lodging donation, and Dr. Perez and his partner and staff. A huge thanks to Christa for her support and pompoms as we went thru this.... I can't wait to be pregnant together. ;-)


This process is hard enough to go through, and it was not easy doing it out of the country. It was stressful and there are many things I would have done differently.

But as we sat in the waiting room, a couple days back... just prior to our egg retrival... it was quiet. Just some (spanish) whispering going on... and the elevator. I had a moment of peace, and a sense of "everything is going to be ok."
Then that moment gone and went, and the panic returned.
As if on cue... someone walked by and whistled really loud, the 1st couple bars to "Don't Worry, be Happy" in perfect pitch. I later learned it was Dr. Perez's partner. He loves to whistle. He had no idea how much I needed that tune. Right then. Right now.
My eyes filled up with tears, and that susie sunshine chit I do so well, returned.
Don't worry. I'm happy.
I'm about to mother others. I just know it!

What's on our mind?

Tracie e-mailed me today asking a question.

 What are your 3 worries and 3 fun things you are looking forward to on this trip? 

My answers were as follows:

Worries:

1) One of us gets sick or is physically not able to go through with it the procedure.

2) OHSS

3) We get there and they pull a fast one on us with fees.



Looking forward to:

1) meeting Tracie and Ava:)

2) getting to see two beautiful countries

3)having new experiences!!


Tracie made me do my own before I looked at hers which were:

Worries:

1) Something physically stopping us from going

2) Bunk embryos

3) OHSS



Looking forward to:

1) Shopping local markets

2) Getting a great fert report

3) Toes in the sand and surf at midnight
 
What would be the top 3 worries/3 things you would be looking forward to?  What do you think we should be worried about?

We need your shoes

No, not the ones that are on your feet.  The ones you don't use anymore.  Tracie has this GREAT idea of donating shoes to local shelters.  Got any?? Email us at ticoandlupe@gmail.com!

More Q&A- Christa&Tracie

Where are the snow babies kept if you have any that make it to freeze?

They are kept in Panama where they are ready for either donation or an FET.

If my cycle doesn't succeed, will I try again with a frozen FET?

Christa-A FET is an option, but I'm not sure how soon we would do it. Depends on funds and time off. I'm the only one who will essentially need time off because the embryos will already be down there, but it's still difficult with everything we have going on in our normal, everyday life.

Tracie: Yes. As soon as we can, I hope. I will mother others.

Are all of us going (IE- husbands, kids)-

Yes, all of us are eventually going to be there. Tracie, Ava, Christa, Adam, and Ella are traveling down there first and Davez is meeting us there a couple of days later. We are staying together most of the time, and Tracie, Davez, and Ava are taking a brief trip to the coast when we don't have doctors appts for a stretch of time.

Was it difficult to convince your DH to do this IVF Vacation?

Christa- At first, I think Adam was kind of wary of going to another country for medical care, but with all the research that both Tracie and I did, he was almost immediately convinced.

Tracie- I think we both took a while to get used to the idea. I still can't believe our journey has led us here. NEVER did I think we'd have to do IVF. Never. But the idea of doing something unconventional like out-of-the-country IVF is right up our alley. We traveled around the world for 6 months straight in 2006... traveling is our "thing" to say the least. So this kinda' "fits" us, I guess.

Davez still tries to change the whole plan (which is now 99% booked) to going to Thailand instead, but logistically, this just makes more sense. To be honest, I didn't think he'd go for it. Then I thought he went for it to shut me up. Now he's on board. Nervous, and displacing over it, but on board. His biggest fear is not having time to chill by himself, and having Ava loose her chit on the airplane. I got both handled, we'll be fine.


Do you know each other or will you be meeting for the first time in Costa Rica?

This is the exciting part. We have only been email chatting and will be meeting each other for the first time in the baggage terminal where Tracie has already said that she is going to try not to laugh at my "East Coast" accent:)

Tracie: Little does Christa know, I'm actually a 13 year old zit-covered kid from Portland, Oregon. I've been foolin' all your asses for years now. Surprise!

What do your families think about this?

Christa- my parents have been very supportive, my mom was a bit skeptical at first because the first plan was for the girls to go for half and the guys to go for the other. She was upset Adam wasn't going for the whole time and we were going to be "alone" in a foreign country. But she's ok with it especially now since Adam is coming for the whole thing. Honestly, I was a little bit scared of flying all that way with Ella on my lap especially since I hate flying (I get very sick and my ears won't pop). So I'm glad to have the help.

My in laws have been great, helping us book some of their time share so we don't have to pay to stay at certain times during the trip. BIG HELP!!! They are very supportive of our adventure.

Tracie- Hhhmm, that's still pending. My mom is scared, I think. Of the unknown. I tried to explain the process to her last nite, and she says "OMG, this is all very complicated." Um, yes. It is. My dad doesn't say much. We've not said anything else to other family yet. Not sure what we'll do with this.

Our biggest fear is that a child that comes from this process will be LABELED. Which happens sometimes, as much as we'd like to think it doesn't. This has been one helluva journey for us. Although I am bummed (read: ashamed) my body has not worked for us well, I will be extremely proud of any child that comes from this. No matter HOW they got into my belly. I wish Guiana & Bill Rancic were not the ones paving the way for people being open about Infertility. I wish superstars would not keep this problem a secret. I wish no one had to deal with it, but if someone does, I would sure love for that shroud of (whatever it is) to not cover it.

Rant over. Sorry. I don't care what people think, we're doing what is best for our family.

As always, feel free to ask any other questions you have, we are happy to answer.

Q&A Christa

I'm going to make an attempt to answers some of the questions asked in the comment section of last post.  These are Christa's answers, Tracie will answer some soon!  

• 1)How many babies would you like for the IVF to produce? Are you secretly hoping for twins? Obviously a healthy baby & pregnancy is your main hope.    I would like one healthy baby.  BUT, I would be happy being pregnant and while I know there are many more risks to a twin pregnancy, I would be ecstatic with twins also.    
• 2)If this IVF is not successful (notice, I did not say, a failure..) will you try again?    It's tough to say.  We are running out of resources (mostly because of money), but will try again in the future sometime.  Hopefully this won't have to be a question;) 
• 3)How many children do you want to complete your family?

•   This is a sticky question in this household!  While I am so happy with Ella, I've always wanted 3 or 4 children and even more so now that we have Ella and we know what joy she brings to our life.  Adam would be happy with two.  Hopefully we will come to a compromise someday.

• 4)I'd love to hear about all the pre-contact that you have had with the doctors.   I've worked a lot with Mark from Passport Medical.  He helps us get our medical records to the doctor and also helps with scheduling and any questions we may have for the doctor.  I've been in email communication with Dr. P (our RE in Costa Rica) and he is very familiar with severe Endometriosis, so that's been good.  Also, I've been working with an RE here in Maine to get my required tests completed.  I've had them done before, but Dr. P requires that they be done withing one year of the procedure, which is understandable. 
• 5)Do you have to go down with a full diagnosis or are they going to work through your various issues?  I don't know the exact answer to that question, but I think he wants you to have some idea of what is going on with your body.  If something doesn't sound right to him he will definitely tell you.  
• 6)Have you already sent them your entire medical file?   No, just the tests required, everything else you can bring with you when you go and he will look over them before you start your required dosage of meds.   If anyone has any other questions, I would be happy to answer.

Lets Compare Cost of IVF by Country

  

	USA	Canada	Barbados	Costa Rica / Panama	Argentina
IVF	$12,000	$5000	$6000	$2800	$4000
ICSI	$13,500	$6500	$7000	$2800	$4000
Egg Donor IVF	$25,000 – $40,000	N/A	$7500	$3000	$4600
PGD	+$3550	N/A	+$3750	N/A	+$4500

 
Embryo Glue, Blastocyst, and Cytoplasmic Transfer are all included in the cost of Costa Rica/Panama's IVF price.

Also, in Costa Rica/Panama if other special services are required, the prices are among the lowest in the world.

• Embryo freezing $500 (includes all embryos obtained).
• Transfer of frozen embryos $1000
• Ovum donor $3000 (includes medication for the donor). You may also provide your own donor and pay only $200 for the anesthetics, plus the cost of medication (approx. $1400).
• Sperm donor $200.
• Epididymal and Testicular aspiration $600 (includes anesthesiologist).
•  sources:http://www.centrofecundar.com/, http://passportmedical.com/2009/11/fertility/
  

Fundraising fun!! Felt Playhouses!

Tracie has this wonderful creative knack, so we decided to put that to good use and collectively make some awesome felt playhouses. They are available through this blog!  More information here !!

Here is the beautiful felt playhouse she made for Ava:

We make panels so you can pick and choose your own decor!

What goes into an IVF Vacation you ask?

Why, a lot goes into it! T and I started with Googling a lot and she came across a gentleman from Passport Medical named Mark. He and T started talking at first. He specializes in organizing these trips and believe it or not, his wife and he are going through IVF in May also.

We researched CIMA Hospital in Costa Rica and Hospital Panama, obviously in Panama. State of the art equipment including a 4d/5d ultrasound machine! We found that everything was up to or exceeding American standards and were very pleased. We also did a bunch of research on Dr. Perez. His success rates were phenomenal and everything that is required for IVF in the states is also required by him. He needs a CD 3 FSH level, an SHG, a semen analysis from the spouse and other various types of blood work.

After getting some additional questions answered by Mark, we started looking at airfare, accommodations, and costs of living in Costa Rica and Panama for 3 weeks. After regurgitating stats and dollar signs on paper, we have found that we are going to shell out between 1/3 and 1/2 of what we would pay in the states (I will go into breakdown of costs soon). Plus we get to embark on this journey in countries full of palm trees and beaches.

Thanks to Adam's parents we are all staying at their timeshare for the majority of the time we are there, so we cut that cost. Thank you Pat for all the calling around you did, we really appreciate it and understand all the hard work that went into it.

We are STILL planning two months later, so it does take a while to get everything ready and in order. Trying to get all these tests done and out to Dr. Perez has been one of the challenges, also Tracie and I live 1500 miles away from each other, which also makes our communicating about plans a bit challenging.

If I haven't answered all of your questions, I'm probably not thinking of something, we are prepared to answer questions, you can either comment or email either T or I!

Tracie

When I was a kid, I was a 'helluva homemaker. I would cook all day in my easy-bake oven, going through lightbulbs after lightbulbs. I nurtured my babydolls, dressed them in pretty frocks, and even in my teen years when I was supposed to be chasing boys, I was running a babysitting business each weekend. I chose to be a nanny over flipping burgers. I had baby names picked out when I was 12.

I was meant to mother.

For those of you that don't know my story, I goofed around thru my 20's, and finally met The One, Davez, pushing 30. We have had an incredible journey so far, a good part of it spent on a plane on in another country. We LOVE to travel.
We finally started a family, and had our amazing daughter Ava Claire. (just turned age two) Davez is an incredible daddy, and we just adore this amazing little person. We had hints of trouble before she was born, but thought all was well once we got her. Beautiful pregnancy, nice birth... we got this pregnancy thing DOWN !

Or notsomuch.

After she weaned, the hints of trouble became really loud and rude. To date, I've gone thru eight medicated cycles - ranging from clomid to follistim to gonal to ovidrel to lovenox to all the hocus pocus treatments one can google. I've lost 7 pregnancies, most very early, but a special one lingered until 11 weeks, dubbed "Harvey" in our hearts, lost to Trisomy 13.
I've been drained of my blood, had more tests that anyone should ever have, and been given answers only to be told they were wrong, and no one can tell me why this is all happening to us. We define "frustrated" at this point.

So why Costa Rica?
Well, for ME, I can't fathom spending $20K on doing IVF in the states. It's just too much money for us. (to each their own) I can't handle spending it, and I certainly do not have the emotional stability anymore to handle it if it does not work.
So this very affordable "IVF Vacation" idea is RIGHT up our alley. We get to travel to one of the finest hospitals, get state of the art treatments, see new places, try new markets... and hey, if we get a stow-away, even better.

Sometimes it's really hard for me to stand there and look at all the signs, observe all the facts, and try to make sense of what's real.

But there's one thing I know in my heart....
I will mother others.
And we're off on this adventure to see if this is HOW that statement comes true.

Christa

So many things consuming my mind, what if it doesn’t work, what if I get sick, what if this isn’t the best decision for our family, what if, what if, what if.

I can’t believe it’s come to this.  IVF.  Our final option.

  After our precious Ella, we decided to try for another about 6 months after she was born.  I weaned her off the breast (one of the hardest decisions I’ve ever had to make) and got pregnant that first month of trying.  It was another miracle!  Our 10% chance was happening again.  No medical intervention at all.  

I knew in my heart it was over before it began.  While my betas were good and doubled, the first time I saw the baby measuring a few days behind on the u/s I cried.  The u/s tech said “don’t worry, they can run a few days off at first, maybe you just miscalculated your dates” (I know my dates like the back of my hand).  The midwife said the same thing.  Over and over again, repeated u/s’s saying that the baby was measuring small. At 6.5 weeks, there was only a small flutter.  After a week of waiting,  we finally went in for an u/s at the hospital and at 8 weeks pregnant, the baby was measuring 6w3d with no heartbeat.  Whatever heartbeat was there in the first place was gone. We were made to wait another week just in case.  The follow up u/s showed no growth, but my uterus was still growing.  Missed miscarriage.  D&E was scheduled.  There were some of the most exhausting days of my life to follow.

We took a couple months off to enjoy the summer and Ella figuring if we could get pregnant on our own again, it would happen with time.  This was last April.  After 5 rounds of Clomid and 2 IUI’s we still aren’t pregnant and my endo is back full force.  I have stage IV endo.  No surgeon dares to go back in fearing they will just create even more scar tissue.  I’ve already had 3 laps, there isn’t much more they can do at this point anyhow.

IVF is the only option left for me.  Nothing is making it through my tubes at this point and I’m not even sure if I can ovulate without assistance anymore.  With all these things going through my mind, all these “what if’s”, I know through it all that I have the love and support of my family and friends to hit the purchase button and buy my ticket.

 I’m going to Central America.  To get the best souvenir ever.  A baby.